Provider Demographics
NPI:1467675009
Name:CYNTHIA GULICK, PC
Entity Type:Organization
Organization Name:CYNTHIA GULICK, PC
Other - Org Name:SOUTHWEST FAMILY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GULICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-620-5556
Mailing Address - Street 1:11900 SW GREENBURG RD
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6453
Mailing Address - Country:US
Mailing Address - Phone:503-620-5556
Mailing Address - Fax:503-624-0118
Practice Address - Street 1:11900 SW GREENBURG RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223
Practice Address - Country:US
Practice Address - Phone:503-620-5556
Practice Address - Fax:503-624-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO15813207Q00000X
ORDO20679207Q00000X
ORDO14860207Q00000X
ORMD28256207Q00000X
ORPA00425363AM0700X
ORPA00890363AM0700X
ORPA00941363AM0700X
ORPA00474363AM0700X
OR096007344363LF0000X
OR91007287363LF0000X
OR079044143N1363LF0000X
OR095006531367A00000X
OR200350075367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDO15813OtherDR. GULICK LICENSE
OR1780756494OtherDR. GULICK NPI NUMBER
OR1780756494OtherDR. GULICK NPI NUMBER
ORBG1600471OtherDR. GULICK DEA NUMBER
ORBG1600471OtherDR. GULICK DEA NUMBER
ORR116193Medicare ID - Type UnspecifiedMEDICARE BUSINESS NUMBER